Creating Conditions for Change

Sustainably reducing medical overuse requires change in established practice patterns. Like any behavior change, it requires attentive cultivation of an environment where change feels safe, possible, and supported at all levels of an organization. We believe the following four change concepts will help health care organizations create the conditions for success of the other two: Engage in sense-making conversations and Care teams take ownership.

Emphasizing the seriousness of reducing medical overuse can encourage health care providers and front-line staff to dedicate the time necessary for change to occur. Leadership at every level of an organization can convey the priority of this work through a consistent message and actions that demonstrate committed support.

Make protected time and space available for facilitated discussions about overuse.

Establish clear roles and teams to lead overuse reduction initiatives.

Allocate or obtain resources to support value-based care initiatives.

Conversations about the potential for harm from overused services are more productive where both mutual trust and a commitment to improving care exist. In this environment, everyone shares a vision of care that is safe and effective, conversations about overuse are non-judgmental and non-punitive, and creative thinkers are welcomed.

Key Changes

Provide training and educational resources on value-based care and strategies for reducing overuse.

Commit to maintaining a safe, non-threatening, blame-free environment for clinicians and teams to compare experiences and exchange ideas about reducing overuse.

When individuals align around a shared purpose, they have a framework for focusing the direction of change. A shared understanding of the language used to speak about an issue (e.g., overuse, low-value care, safe, effective) makes conversations more productive and ensures everyone is moving in the same direction.

Key Changes

Establish shared purpose by linking overuse reduction initiatives to the organization’s strategic priorities and a larger professional movement.

Health care providers often underestimate how frequently they deliver a specific service, and they are typically unaware of how their behavior compares to peers. Transparently sharing reliable, trusted measures of use at the individual level can spur health care providers to work toward a shared purpose of reducing medical overuse and greater alignment with their peers.

Key Changes

Devote time and resources to defining, clarifying, and validating measures of overuse.